NPIMap

Individual provider Active NPI

Bryan D. Clark, D.O.

  • Emergency Medicine Physician
  • Pulaski, VA
National Provider Identifier
1194742643
Registry record updated Dec 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
0102201448 Issued in VA
Practice address
2400 Lee Hwy N
Pulaski, VA 24301-2326
Phone
(540) 994-8100
Fax
(804) 379-7506
NPI assigned
Jul 17, 2006
Last updated
Dec 3, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 0102201448 VA Primary
Hospitalist Physician 208M00000X 0102201448 VA

Addresses

Primary practice location

2400 Lee Hwy N
Pulaski, VA 24301-2326

Mailing address

2250 Castlebridge Rd
Midlothian, VA 23113-4009
Phone (804) 513-7550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040712000090 VA Practitioner - Emergency Medicine 0648258129 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ingleside Emergency Group LLCGroup PAC ID 1355698317, 29 clinicians

Practice addresses (Care Compare)

1 Arh LN
Low Moor, VA 24457-5702
Phone (540) 862-6011

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.73 of 100Reported as group
Quality
86.53
Improvement activities
40
Cost
86.33

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Wildwood Emergency Group, LLC Emergency Medicine CurrentSince Jul 9, 2018 Accepting new patients
Ingleside Emergency Group, LLC Emergency Medicine CurrentSince Jul 9, 2018 Accepting new patients
Kingsford Emergency Group, LLC Emergency Medicine CurrentSince Jul 9, 2018 Accepting new patients
Kingsford Physician Services, LLC Hospitalist CurrentSince Jul 9, 2018 Accepting new patients
Virginia Emergency Physicians LLP Emergency Medicine Past Accepting new patients
Virginia Emergency Physicians LLP Emergency Medicine Past Accepting new patients
Columbia Healthcare of Central Virginia Inc PastSince Apr 1, 2019 Accepting new patients
Riverside Physician Services, Inc. Emergency Medicine Past Accepting new patients
Virginia Emergency Physicians LLP Emergency Medicine Past Accepting new patients
Virginia Emergency Physicians LLP Emergency Medicine Past Accepting new patients

Locations

3700 S Main St
Blacksburg, VA 24060
Phone (540) 951-1111

1 Arh Ln
Low Moor, VA 24457
Phone (540) 862-6223

2400 Lee Hwy N
Pulaski, VA 24301
Phone (540) 994-8100

Interoperability endpoints

  • Direct secure messaging: bclark11978@direct.rivhs.com

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543795200000",
    "number": "1194742643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 CASTLEBRIDGE RD",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231134009",
            "telephone_number": "804-513-7550",
            "fax_number": "804-379-7506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 LEE HWY N",
            "city": "PULASKI",
            "state": "VA",
            "postal_code": "243012326",
            "telephone_number": "540-994-8100",
            "fax_number": "804-379-7506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BRYAN",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2018-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0102201448",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "VA",
            "license": "0102201448",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pulaski, VA

Sources for this page

Verify at the official NPI Registry.